NC Register Volume 21 Issue 09 - Office of Administrative Hearings

CONTESTED CASE DECISIONS
"Paraprofessional" within the mh/dd/sas [mental health/developmental disabilities/substance abuse services] system of care means
an individual who, with the exception of staff providing respite services or personal care services, has a GED or high school
diploma; or no GED or high school diploma, employed prior to November 1, 2001 to provide a mh/dd/sa service. Supervision shall
be provided by a qualified professional or associate professional with the population served. The supervisor and the employee shall
develop an individualized supervision plan upon hiring. The parties shall review the plan annually.
The federal Centers for Medicare and Medicaid Services note a “consideration” concerning the delivery of a waiver service, such as
that in question in this action, Supported Employment:
B. Considerations Related to Specific Services.—
1. FFP [Federal Financial Participation] is not available for personal care services or any waiver services when provided to
recipients by legally responsible relatives, i.e., spouses or parents of minor children, when the services are those that these
persons are already legally obligated to provide.
2. Services provided by relatives or friends, except as noted in item B.1., may be covered only if the relatives or friends
meet the qualifications for providers of care, there are strict controls to assure that payment is made to the relative or friend
as providers only in return for specific services rendered, and there is adequate justification as to why the relative or friend
is the provider of care, e.g., lack of other qualified provider in remote areas. Medicaid payment may be made to qualified
parents of minor children or to spouses for extraordinary services requiring specialized skills (e.g., skilled nursing, physical
therapy) which such people are not already legally obligated to provide.
State Medicaid Manual, §4442.3
BASED UPON careful consideration of the stipulations of the parties, the sworn testimony of the witnesses presented at the
hearing, the deposition of Mr. Piper, documents and exhibits received and admitted into evidence, and the entirety of the record in this
proceeding, the Undersigned makes the following findings of fact. In making the findings of fact, the Undersigned has weighed all the
evidence and has assessed the credibility of the witnesses by taking into account the appropriate factors for judgment of credibility,
including but not limited to the demeanor of the witnesses, any interests, bias, or prejudice a witness may have, the opportunity of the
witness to see, hear, know or remember the facts or occurrences about which the witnesses testified, whether the testimony of the
witness is reasonable, and whether the testimony is consistent with all other believable evidence in the case.
FINDINGS OF FACT
Petitioner
1. Petitioner, Mr. Worley, is 21 years old and lives with his mother, who is his guardian. (Joint Pre-Trial Order, filed July 5,
2005). His grandparents’ live on the same tract of land and can, depending on their own health issues, provide care. (Respondent’s
Ex. 1, p. 4, T pp. 15, 86-87)
2. Petitioner presents as a large individual, 5’7”, 210 lbs. (Respondent’s Ex. 1, p. 9, Piper Deposition, pp. 12, 39)
3. Petitioner is diagnosed with Personality Disorder due to Medical Condition – Combined Type: Disinhibited & Aggressive,
Mild Mental Retardation, Moyamoya Disease (a progressive cerebrovascular disorder caused by blocked arteries at the base of the
brain in an area called the basal ganglia); Transcerebral Ischemia; History of Major Motor Seizure/Petit mal absent. (Joint Pre-Trial
Order, filed July 5, 2005; T pp. 37, 67, 97-99; Piper Deposition, p. 9; Respondent’s Ex. 1, p. 3). His last stroke occurred at age 13.
(T. p. 71)
4. Petitioner’s most recent psychological assessment (dated August 30, 2005) found him to fall within a moderate to mild range
of mental retardation. “He displayed relative strengths for tools, domestics, and health and safety, suggesting that he possesses some
practical daily skills. As was suggested with the Vineland Adaptive Behavioral Scales, [Petitioner] functions at a very low level with
regard to basic concepts. He maintains only a rudimentary understanding of time, money or measurements. Nevertheless, when
compared to a group of neuropsychologically disabled adults, he functions fairly well given his disabilities.” (Respondent’s Ex. 7,
p.3) Petitioner’s Vineland Adaptive Behavioral Scales showed a composite score of 41, which resulted in a finding that he possesses
the adaptive behavioral skills of an individual of age six years, seven months. (Id. at p. 4)
5. Petitioner, at the time of hearing was prescribed a variety of medication. As noted in Petitioner’s Medical Information with
his CAP-MR/DD Plan of Care (Respondent’s Ex. 1, pp. 3-4):
a. Risperdal (Improve clarity, reality basing);
b. Topamax (Helps Seizure control);
c. Lamictal (Helps Seizure control);
d. Diclofenac (Cataflan) (Analgesic – Headache pain; anti-inflammatory);
e. Baby aspirin (Blood thinner, reduces strokes);
21:09 NORTH CAROLINA REGISTER NOVEMBER 1, 2006
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